Anesthesia for patients with an anterior mediastinal mass
- Javier Lasala, MD
Javier Lasala, MD
- Assistant Professor
- The University of Texas MD Anderson Cancer Center
- Ron Purugganan, MD
Ron Purugganan, MD
- Professor of Anesthesiology and Perioperative Medicine
- Professor of Thoracic and Cardiovascular Surgery
- The University of Texas MD Anderson Cancer Center
Mediastinal masses may be small, slow-growing, and asymptomatic, or large, aggressive, symptomatic tumors (figure 1 and table 1). This topic discusses anesthetic care of patients undergoing a surgical procedure (eg, biopsy or resection) for diagnosis or treatment of an anterior mediastinal mass. Preanesthetic assessment, intraoperative anesthetic management, and early postoperative care are addressed.
Initial evaluation of mediastinal masses is discussed separately. (See "Approach to the adult patient with a mediastinal mass".)
The major goal of the preanesthesia consultation is to assess risk of airway or respiratory compromise and/or hemodynamic instability due to:
●Mass effect on the airway and lungs.
●Mass effect on major cardiovascular structures and circulation.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- PREANESTHETIC ASSESSMENT
- Focused history and examination
- Preoperative tests and interventions
- CONSIDERATIONS FOR SPECIFIC SURGICAL PROCEDURES
- Minimally invasive approaches
- - Cervical mediastinoscopy and anterior mediastinotomy (Chamberlain procedure)
- - Thoracoscopy
- Open approaches (thoracotomy, sternotomy, thoracosternotomy)
- ANESTHETIC PREPARATION AND MANAGEMENT
- Vascular access
- Blood availability
- Planned epidural analgesia
- Induction of anesthesia
- Airway management
- - Preparation for airway control
- - Airway management during induction
- - Airway management during maintenance
- Hemodynamic management
- - Hemodynamic monitoring
- Intraarterial catheter
- Central venous catheter
- Other monitoring modalities
- - Hemodynamic management during induction
- - Hemodynamic management during maintenance
- - Planned cardiopulmonary bypass
- Emergence and extubation
- POSTANESTHETIC MANAGEMENT
- Emergency complications
- Pain management
- SUMMARY AND RECOMMENDATIONS